Assessment of Oral Health-Related Quality of Life Using the Oral Impact on Daily Performance (OIDP) Instrument Among Secondary School Teachers of Modinagar, Uttar Pradesh: A Cross-Sectional Study.

Introduction Oral health has an impact on a person's general health, well-being, and quality of life. Due to their expertise and interactions with people, school staff members can actively contribute to the promotion of children's health if provided with the proper training. Methodology A cross-sectional survey was conducted to assess the "oral health-related quality of life" using the Oral Impact on Daily Performance (OIDP) instrument among the secondary school teachers of Modinagar, Uttar Pradesh. The study included a sample of 400 government secondary school teachers and 400 private secondary school teachers. The independent sample t-test was performed to assess the relationship between the mean of OIDP dimensions and the prevalence of dental caries. Any p-value less than 0.05 was considered significant. The data was analyzed using the SPSS version 20.0 software package (IBM Corp., Armonk, NY). Results In the present study, most of the participants (174 (43.5%) government teachers and 197 (49.2%) private teachers) were in the age group of 41-50 years. According to the Decayed, Missing, and Filled Teeth (DMFT) index, the mean decayed teeth present for government and private school teachers were 0.45 ± 0.503 and 0.41 ± 0.493, respectively, and the mean DMF scores for government and private teachers were 1.27 ± 0.736 and 1.03 ± 0.757, respectively. There was a positive correlation between the DMFT scores and the mean scores for the dimensions of the OIDP among both government and private secondary school teachers. Conclusion The poor dental health status of teachers' has a bad impact on everyday performance and academic work. The findings of the study highlight the need for oral health education and good oral health maintenance among school teachers since they are the ones who can easily influence the behavior of the children.

Association Between Pulmonary Hypertension and Its Effect on 30-Day Mortality, Readmission, and Cost After Transcatheter Aortic Valve Replacement: A Multicenter Study.

Background Pulmonary hypertension (PH) is commonly seen in patients with severe aortic stenosis. Transcatheter aortic valve replacement (TAVR) has been shown to improve PH, however, its impact on clinical outcomes and cost remains unclear. Methods We did a multicenter, retrospective analysis of patients undergoing TAVR in our system between December 2012 to November 2020. The initial sample size was 1356. We excluded patients with prior history of heart failure, with a left ventricular ejection fraction of 40% or less, and patients who had active symptoms of heart failure within two weeks of the procedure. Patients were divided into four groups based on their pulmonary pressures, using right ventricular systolic pressure (RVSP) as a surrogate for PH. Groups included patients with normal pulmonary pressures (<35mmHg), mild (35-45mmHg) moderate (46-60mmHg), and severe PH (>60mmHg). Primary outcomes included 30-day mortality and readmission. Secondary outcomes included length of ICU stay and cost of admission. We used Chi-square and T-tests for demographic analysis of categorical continuous variables respectively. Adjusted regression was used for the reliability of correlation between variables. Multivariate analysis was used for final outcomes. Results Final sample size was 474. Average age was 78.9 years (SD: 8.2, 53% Male). Thirty-one percent (n=150) had normal pulmonary pressures, 33% (n=156) had mild PH, 25% (n=122) had moderate and 10% (n=46) had severe PH. Patients with history of hypertension (p-value<0.001), diabetes (p-value<0.001), chronic lung disease (p-value=0.006) and those on supplemental oxygen (p-value=0.046), had significantly higher proportion of patients with moderate and severe PH. We found significantly higher odds of 30-day mortality in patients with severe PH (OR: 6.77, CI: 1.09-41.98: p-value 0.04) compared with normal or mild PH. There was no significant difference in 30-day readmission (p-value=0.859) between the four groups. Cost did not change with severity of PH (Avg: $261,075: p-value=0.810). Patients with severe PH spent a significantly higher number of hours in ICU, compared with the other three groups (Mean: 18.2, p=value <0.001). Conclusions Severe pulmonary hypertension significantly increased the odds of 30-day mortality and ICU stay in TAVR patients. We did not see any significant difference in 30-day readmission and cost of admission, based on PH severity.

Study of Association Between Different Coronary Artery Disease Presentations and Its Effect on Short-Term Mortality, Readmission, and Cost in Patients Undergoing Percutaneous Coronary Interventions.

Introduction Atherosclerotic coronary artery disease (CAD) is the major cause of mortality in the USA. CAD requiring percutaneous coronary intervention (PCI) can have a wide spectrum of presentations. We reviewed the cost of admission and PCI at the tertiary care center stratified for different CAD presentation types. Methods We performed a retrospective study of 7,389 patients undergoing coronary angiogram at our facility from 2015 to 2017. Patients were selected from CathPCI registry. Chart review was done for readmission and death data. Cost data were provided by the finance department. Patients going for coronary artery bypass surgery (CABG) were excluded. We split the patients based on their need for PCI. Cost analysis was based on CAD presentation types (No symptoms, atypical symptoms, stable angina, unstable angina, NSTEMI [non-ST segment elevation myocardial infarction], STEMI [ST-segment elevation myocardial infarction]). Adjusted linear regression was run for the outcomes. Primary outcomes were 30-day readmission and death. The secondary outcome was cost of admission. Results The final sample size was 6,403. The mean age was 65.6 years (SD: 12.5; male: 63.8%). 2444 required PCI (38%; p < 0.001). PCI group had lower mean age (62.5 years; SD: 12.3, p<0.001) with lower BMI (30.6 vs 31.1, p=0.015). PCI group had significantly lower odds for 30-day readmission (OR: 0.63; CI: 0.45-0.89; p=0.009) and 30-day mortality (OR:0.60; CI: 0.41-0.89; p = 0.011). A severe presentation increased the odds of getting PCI. Cost of admission was higher in all groups receiving PCI. Conclusions PCI group had better 30-day readmission and mortality rates. PCI increases the cost of admission in all CAD types.

Relation of Frailty to Cost for Patients Undergoing Transcatheter Aortic Valve Implantation.

Frailty is associated with significant morbidity and mortality for patients undergoing transcatheter aortic valve implantation (TAVI). In addition to clinical outcomes, cost is an important factor to inform clinical decision-making around TAVI. However, the association of frailty with cost is unknown. This study tested whether frailty was associated with cost for adult patients who underwent TAVI at a moderate-volume single center between December 2012 and April 2018 (n = 431). Frailty was determined from pre-TAVI clinical visits as a composite of 2 markers: 5-meter walk time (abnormal: >6 seconds or unable to perform) and serum albumin (abnormal: <3.5 g/dl). Patients were excluded if missing frailty assessment or covariate data (24). Cost data were derived from financial statements, and assigned at the department-level by charge code. Multivariable regression models were adjusted for age, gender, and procedural co-morbidities. Of 407 patients in the analytical sample (mean age 81 years, 49% female), 74 (18%) were determined to be frail. Adjusted mean total costs were $6,397 higher for frail patients ($78,823 vs $72,425, p = 0.042) compared with nonfrail. Higher total costs were driven by department-level charges associated with longer in-hospital length of stay (7.6 vs 3.3 days, p <0.001): room, physical therapy, pharmacy, laboratory, supply, and imaging services. Providers must address frailty proactively to salvage the benefit associated with TAVI.

Troponin Levels at Presentation Before Coronary Angiogram and Their Association With Cost, Mortality, and Readmission.

Background and objective In patients undergoing coronary angiogram, the degree of cardiac enzyme elevation at presentation has been thought of as a strong and independent predictor of in-hospital mortality and readmission. Recent studies, however, have suggested a lack of clarity regarding this speculation, particularly with regard to troponin elevations. Additionally, the impact of troponin levels (TnI) at presentations on cost is poorly understood. In this study, we aimed to evaluate the association of Tnl at initial presentation with 30-day all-cause readmission and all-cause mortality as well as admission costs. Methods This study was a retrospective analysis of 7,388 patients who underwent coronary angiogram at our facility from 2015 to 2017. Patients were identified from a local CathPCI Registry® registry, and a subsequent chart review was performed for readmission and mortality data. Cost data were provided by our in-facility finance department. We excluded patients with incomplete records and those who required coronary artery bypass grafting (CABG). After the exclusion of patients deemed ineligible, the final sample size eligible for analysis was 1,163. Patients were divided into two groups based on Tnl at presentation with a cut-off value of 0.04 ng/ml. Adjusted regression and multivariate analysis were used for clinical outcomes. Primary outcomes were 30-day readmission and mortality. The secondary outcome was the admission cost. Results Within our cohort, the average participant age was 64.6 years (SD: 12.7), and the majority of them were male (70.7%). Of these patients, 207 had lower TnI (<0.04 ng/ml), while 956 had higher TnI at presentation. The high TnI (≥0.04 ng/ml) group had a significantly higher number of patients with a family history of coronary artery disease (CAD) (13.8% vs. 7.7%: p=0.017) and those on dialysis (3.2% vs. 0.5%: p=0.028) compared to the low Tnl group. Additionally, we did not find any significant difference in 30-day mortality or readmission between the two groups in our cohort. On average, each patient in the high TnI group spent $936 more for hospital admissions compared to patients in the low Tnl group. However, this difference was not statistically significant. Conclusions Tnl at admission did not reveal a significant impact on 30-day mortality or readmission, which is consistent with the findings of previous studies. A high Tnl at admission increased the cost of admission; however, the difference was not statistically significant in our cohort.

Conscious Sedation Versus General Anesthesia in Transcatheter Aortic Valve Replacement: A Cost and Outcome Analysis.

Background Transcatheter aortic valve replacement (TAVR) has emerged as an alternative treatment for aortic stenosis in patients who are at moderate to high risk for surgical aortic valve replacement. The use of conscious sedation (CS) as compared with general anesthesia (GA) has shown better clinical outcomes for TAVR patients. Whether CS has any cost-benefit is still unknown. We analyze our local TAVR registry with a focus on the cost comparison between CS and GA for the TAVR population. Methods It is a retrospective chart review of 434 patients who received TAVR at our local center from December 2012 to April 2018. Patients who had their procedure aborted and those requiring a cardiopulmonary bypass or surgical conversion (16 patients) were excluded. The final sample size was 418. Patients were divided into two groups based on whether they received CS or GA. Primary outcomes were intensive care unit (ICU) hours, length of stay in hospital, readmission, or death at 30 days. The secondary outcome was the cost of TAVR admission. The cost was divided into direct and indirect costs. The student's T-test and chi-square tests were used for continuous and categorical variables, respectively. Adjusted logistic regression and multivariate analyses were run for primary and secondary outcomes. Results Of the 418 patients (age: 80.9±8.5, male: 52%) CS was given to 194 patients (46.4%) while GA was given in 224 patients(53.6%). The GA group had comparatively older age (81.8 vs. 80.0; p=0.03) and a higher average Society of Thoracic Surgery (STS) score (8.4 vs 5.7; p<0.001). Patients who received CS had a significantly shorter ICU stay (31.5 vs. 41.6 hours, p<0.001) and total days in the hospital (2.9 vs. 3.8 days, p=0.01). Readmission and mortality at 30 days were not different between the groups. There was no statistical difference in cost between the two groups ($72,809 vs. $71,497: p=0.656). Conclusion Using CS compared with GA improves morbidity for TAVR patients, in the form of ICU stay and the total length of stay in hospital. We did not find a significant difference in the cost of TAVR admission between CS and GA.

Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: A Cost Analysis.

Background Transcatheter aortic valve replacement (TAVR) can be complicated with a complete atrioventricular block requiring permanent pacemaker (PPM) implantation. The cost of index hospitalization for such patients is higher than usual. However, the magnitude of this increased cost is uncertain. We have looked at our five-year TAVR experience to analyze the detailed cost for PPM implantation in TAVR. Methods This study is a retrospective analysis of patients undergoing TAVR at our tertiary care center from December 2012 to April 2018. The initial sample size was 449. We excluded patients with prior PPM or an implantable cardioverter defibrillator (37). Patients who had their procedure aborted or required a cardiopulmonary bypass (16) and those with missing data variables (14) were excluded. The final sample size was 382. The cost for admission was calculated as the US dollars incurred by the hospital. Cohort costs were categorized as a direct cost, which is patient based, and an indirect cost, which represents overhead costs and is independent of patient volume. Patients were divided into two groups based on the placement of PPM after TAVR. Chi-square test, t-test, and logistic linear regression were used for the statistical analysis. Results Of 382 patients, 19 (4.9%) required PPM after TAVR. Baseline variables, including age, gender, and BMI, were not statistically significant. The PPM group had a significantly longer intensive care unit (ICU) stay (48.6 hours vs. 36.7 hours; p<0.001) and total stay in the hospital (4.2 days vs. 3.4 days; p=0.047). PPM implantation after TAVR increased cost on an average of $10,213 more than a typical TAVR admission (p=0.04). The direct cost was also significantly high for the PPM group ($7,087; p=0.02). On detailed analysis, almost all major cost categories showed a higher cost for pacemaker patients when compared with control. Conclusions PPM implantation adds a significant cost burden to TAVR admissions.

Phytochemical screening and assessment of analgesic, Anti-inflammatory and hematological properties of the fruit of Berberis baluchistanica.

Traditionally Berberis species have been used as anti-inflammatory, anti-rheumatic, analgesic and anti-anemic drugs. This study was aimed to determine chemical constituents and to assess analgesic, anti-inflammatory and hematological effects of the crude extract of the berries of Berberis baluchistanica to verify these folkloric claims. Phytochemical screening, carried out by using different chemical reagents and techniques like Thin Layer Chromatography (TLC) and Fourier Transform infra-Red (FTIR) indicated presence of flavonoids, saponins, phytosterols and carbohydrates including reducing sugars. Analgesic and anti-inflammatory activities were assessed on mice by using acetic acid induced writhing method and formalin method. Potent anti-inflammatory and analgesic effects were observed during these experiments. The extract also showed anti anemic effect as it increased the levels of hemoglobin and red blood cells significantly. Increase in the platelet count was also noted. The extract of the berries was used at oral doses of 300 and 500 mg/kg during experiments. Anti-inflammatory and analgesic activities were determined by comparing with the standard i.e. aspirin 300 mg/kg. Both doses produced significant anti-inflammatory and analgesic activities at P<0.05. These activities were seemingly attributable to flavonoid and saponin contents of the drug. These results justify the folkloric claims that the drug could be used as good anti-inflammatory, antirehumatic, analgesic and anti-anemic drug. However, further chemical investigations on the drug are suggested for isolation and identification of compounds that could be safer and more effective than the currently available medicines in treating these disorders.

Prevalence, economic analysis and chemotherapeutic control of small ruminant fasciolosis in the Sargodha district of Punjab, Pakistan.

This study describes the epidemiology, the economic significance of small ruminant fasciolosis in animals slaughtered in the abattoirs of the Sargodha district, Punjab, Pakistan between January and June 2012. In vivo fasciolicidal efficacy of commercially available compounds was examined using a randomised complete block design. Microscopically screened faecal samples revealed 40.51% positive animals for fasciolosis. The prevalent species included Fasciola hepatica (35.64%) and Fasciola gigantica (8.21%). Mixed infections were noted in 3.33% subjects. Prevalence rates were significantly higher in females (42.25%) than in males (39.52%), and in adults (51.20%) compared to younger animals (33.98%). The disease was recorded more often in emaciated animals (63.63%) followed in order by average (43.45%), thin (43.22%), and fat (32.12%) animals. Between January and June 2012, fasciolosis in Sargodha district, Punjab, Pakistan, was estimated to incur US$0.036 million and US$0.177 million direct (liver condemnation) and indirect (carcass depreciation) economic losses, respectively. In vivo fasciolicidal efficacy of oxyclozanide proved to be the most effective method of control, compared to triclabendazole, and levamisole. Results provide useful information on the frequency distribution of fasciolosis and its economic significance. Finally, data on in vivo fasciolicidal trials show that oxyclozanide is the most efficacious compound for the treatment of the disease in the district Sargodha, Punjab, Pakistan.

Assessment of anti-inflammatory, anti-ulcer and neuro-pharmacological activities of Cyperus rotundus Linn.

This article reports the assessment of anti-inflammatory, antiulcer and neuropharmacological activities of crude extract of Cyperus rotundus. The plant exhibited significant property to act as an anti inflammatory agent. In experimental design, inflammation was produced by carrageenan in rats and compare with saline treated and Aspirin treated group. Simultaneously the drug was also observed for its antiulcer response and found effective enough (these two activities were observed at the dosage of 300mg/kg and 500mg/kg). The anti ulcer activity was observed 41.2% as a dosage of 500mg/kg. Neuropharmacological activities (open field, head dip, rearing traction and forced swimming test) were also observed at 300 and 500mg/kg of C. rotundus extract. The crude extract showed mild decreased in all test and exhibited slight muscle relaxant effect. Powder drug studies and FTIR analysis were performed for the authentication of C. rotundus.

Políticas de conflictos de intereses y requisitos para su declaración en las revistas cardiovasculares nacionales de la Sociedad Europea de Cardiología / Conflict of interest policies and disclosure requirements among european society of cardiology national cardiovascular journals

Las revistas biomédicas utilizan la declaración de posibles conflictos de intereses para garantizar la credibilidad y la transparencia del proceso científico. Sin embargo, las revistas no abordan la declaración de conflictos de intereses de manera sistemática ni uniforme. Recientes esfuerzos editoriales conjuntos han abierto el camino a la aplicación de herramientas uniformes para la declaración de conflictos de intereses. En este artículo se presenta una visión integral sobre cuestiones clásicas relacionadas con los conflictos de intereses desde un punto de vista editorial. Además, a partir de los datos de un estudio transversal basado en el empleo de un cuestionario estandarizado, se comentan nuevas apreciaciones sobre las políticas y los actuales procedimientos editoriales relativos a los conflictos de intereses en las diversas revistas cardiovasculares nacionales de la Sociedad Europea de Cardiología.

Disclosure of potential conflicts of interest is used by biomedical journals to guarantee credibility and transparency of the scientific process. Conflict of interest disclosure, however, is not systematically nor consistently dealt with by journals. Recent joint editorial efforts paved the way towards the implementation of uniform vehicles for conflicts of interest disclosure. This paper provides a comprehensive editorial perspective on classical conflict of interest-related issues. New insights into current conflicts of interest policies and practices among European Society of Cardiology national cardiovascular journals, as derived from a cross-sectional survey using a standardized questionnaire, are discussed.